On (Not) Having Health Insurance and S.B. 562 in California (Warning: This Is a Rant, Not a Polished Essay)

I was there (though I don’t see myself in this specific photo).

Even under the American Affordable Care act, more than 25 million Americans do not have health insurance. About 3 million of them live in California.

I am one of them.

This definitely influences my views on health care policy in the United States, but I am uncomfortable about discussing it because, in my experience, when I bring up my own uninsured status in face-to-face conversations about politics, it leads to probing into my personal situation. I am concerned that the people who do this probing are trying to find some ‘gotcha’ which will allow them to discount my situation so they don’t have to change their own political views. I find this to be especially true among Obama supporters who only want to see the good parts of Obamacare and claim it is a ‘universal’ program which solves the problem of access/affordability of health care in the United States (how is it universal if it leaves out tens of millions of Americans?)

If your impulse is to probe me, to find out ‘why’ I am uninsured, whether I could get insurance by some means, whether I *deserve* to get insurance, here is my response: F******* YOU!!!!

Okay, I will be a little more specific than that. One of the most common responses I get (especially from Obama supporters) when I mention my situation is ‘oh, you’ll be okay because you can stay on your parents’ insurance until you’re 26. This response is terrible. Let me list the reasons:

1) I am over the age of 26. Thus, this is of no help to me whatsoever.
2) Even if I were under the age of 26, would these people expect me to remain under the age of 26? How could I stay under 26 forever?
3) This assumes that my parents have health insurance? How do these people know that my parents have health insurance?
4) As it so happens, my parents do have health insurance – due to a government program called Medicare. It is explicitly only for people at or over the age of 65 (with some exceptions). Though I am not 100% sure about this, I don’t think I would be eligible for Medicare even if I were under the age of 26 just because my parents are insured through Medicare.

I know that this policy of putting people on their parents’ insurance plans until they are 26 has allowed people to get necessary health care which they otherwise would not have gotten, and for that I am grateful. However, you don’t get to use it as a rhetorical device to dismiss the concerns of people who the Affordable Care Act has failed to help.

Looking at what is going on in Washington D.C. right now, I know that if the Republicans’ plans to cut back the Medicaid expansion and cause tens of millions of Americans to lose their health insurance so that rich people pay less taxes become enacted, there will be a lot of needless suffering and death. I do not know how to describe how vile that is in words. However, I am not concerned about how it will impact my personal situation, since even the Republicans can’t cause me to lose health insurance if I don’t have it in the first place.

Now, I want to make a very important point clear: health insurance is not the same thing as having access to health care. Some health insurance plans are absolute shit. There are narrow networks – and often patients receive ‘out-of-network’ care without their consent and then have to pay for it (and when someone is PHYSICALLY SICK, do we really expect them to be able to keep on top of whether or not the nurse taking care of them is in-network or out-of-network?) There are health insurance plans with high deductibles/co-pays. And there are some very pernicious ways which health insurance companies mess with the well-being of patients for their own profit. I don’t want to share the individual stories of people I’ve met because I do not have permission, but if you want an example of a health insurance company’s policy recklessly putting someone’s life in danger, you can read the beginning of this article.

Even though I do not have health care insurance, I have better access to health care than some people with shitty health insurance plans. For example, earlier this year, I had a tooth fracture. I was able to get it treated reasonably quickly and within my neighborhood – for $600. Luckily, I was able to pay the $600 (also, that tooth is now covered with gold, which I think is cool). Some people can’t get that kind of treatment in their neighborhoods – they would have to go a far distance. A lot people can’t pay $600 for an emergency medical treatment without risking their access to housing or food. Some people can’t afford the copay for this type of treatment even if they have dental insurance. Some people who have health insurance don’t have dental insurance. Some people can’t reach dentists who will do this kind of treatment for only $600 (most dentists in California would have charged significantly more than $600 to treat a tooth fracture). Some people, even those who have dental insurance, would not have been able to get it treated as quickly as I did – and with tooth fractures, the longer treatment is delayed, the greater the risk of complications (which would require even more treatment, or if it got really bad, removal of the tooth).

Also, I have the option of leaving the United States for medical care, and medical care is much cheaper pretty much anywhere that isn’t the United States. I can afford the travel costs, and if I needed long term treatment, I have dual citizenship, as well as relatives who would take me into their homes if I had to leave the United States for medical reasons. Most Americans do not have that option.

But really, the health insurance system in the United States – both before and after the Affordable Care Act was enacted – is ridiculous. When I was born, I had health insurance – but only because my father had health insurance, and I was immediately recognized as his dependent. And he only had health insurance because he had just been hired – he had been laid off while I was in my mother’s womb, and if he hadn’t gotten a new job before my birth, he would have been uninsured (and me too). My mother, however, did not have health insurance when I was born, so I know my parents tried to get as many of the hospital bills billed to me (because I had health insurance) and not billed to my mother (who did not have health insurance). This is an absurd situation, and a bad way to allocate the costs of health care. Remember, my mother had JUST GIVEN BIRTH, so this was a bad time to impose the stress of bureaucratic hospital billing on her. Really, all the talk about how healthcare would be better if there was a more ‘competitive market’ or more ‘consumer choice’ is bullshit – in order for ‘consumer choice’ to be effective, the consumer needs to be in a good position to negotiate, and people who have medical emergencies are generally in a bad position to negotiate.

Another example of the absurdity of health insurance in the United States is that I will very soon have health insurance again … because I bought travel insurance for my trek, and it covers medical expenses. It’s significantly cheaper than any non-subsidized health insurance policy I know about, even though there are no deductibles or copays (though pre-existing conditions are excluded – that is legal because it is travel insurance). However, one can only use travel insurance when one is travelling (and they can probably only keep the premiums low because really sick people tend not to travel so much). Nonetheless, I find it ironic that health insurance for when I’m in roadless areas of rural Washington is much cheaper than health insurance than when I’m at home in a city with multiple hospitals. I’ve met a number of PCT hikers from abroad who also thought it was ridiculous that the travel insurance policies they bought to cover their medical expenses in the United States are cheaper than the health insurance policies available to U.S. residents.

Enter S.B. 562, the legislation to establish single payer health care in California. For those of you who don’t know what ‘single payer’ is, it basically means that a single entity (in this specific legislation, the government of California) would be responsible for paying most health care costs in California, and that single entity would collect money via taxes, premiums, or fees (S.B. 562 specifically would be funded via tax revenue, not premiums or fees). It’s like the way we fund fire departments – instead of paying for the service of firefighters via fire insurance, the government pays the firefighters, and gets the funding to pay the firefighters via taxes. If you want to know more about single payer, here is a good FAQ.

I have experienced single payer first hand in Taiwan, and I am 100% convinced it is a better way to run a health system. That’s not to say single payer is perfect – the Taiwanese health care system has many problems – but it works much better.

If you are following the politics of S.B. 562, you know that Speaker Rendon shelved it in the Assembly. He claims that he is for single payer, but that the bill is incomplete, is just a statement of principles, and that he needs to shelve it so that nobody can vote on it, amend it, or formally debate it, so that the bill can become more complete..

Huh?

Though Rendon claims that he’s not killing the bill, it’s obvious that this is a move that only someone who is oppposed to S.B. 562 would make. If he thinks the bill has problems, or is too incomplete, or something, then he would propose an amendment, not make it impossible to amend it. And if he’s in favor of single payer, but thinks S.B. 562 is so screwy that it can’t even be amended, then he’d write his own single payer legislation. The reason he’s making it impossible for S.B. 562 to proceed in the California Assembly without proposing alternative single-payer legislation, is that he is opposed to single payer. There is no other plausible explanation.

To be clear, S.B. 562 is incomplete, and it needs amendments. The incompleteness is on purpose, to make the legislation more flexible to political compromise. All of the advocates of S.B. 562 want amendments. But, as I just said, Speaker Rendon has made it impossible for the California Assembly to amend the bill.

And his statement that S.B. 562 is just a statement of principles. I have actually read S.B. 562, and you can too read it too. It is more than a statement of principles. However, even if it were just a statement of principles, I would still favor passing the legislation since it is better than nothing. Legislators pass legislation which is just statement of principles all of the time; it’s far from enough, but it’s not bad either.

And the classic appeal of ‘how are we going to pay for it’ coming not just from Speaker Rendon, but Jerry Brown, and a lot of politicians. Hey, did you know that there is a fiscal analysis which explains how California could pay for single payer. The proposal to fund S.B. 562 is not perfect, and I would welcome attempts to improve the funding mechanisms. If Rendon thinks that the proposed means to fund single payer are too awful to consider enacting, he may say so and explain why he thinks they are awful. However, he has not done that. Instead, he’s ignored the many people who have tried to bring the fiscal analysis to his attention. That shows that he wants CONTINUE to ‘not know’ how to pay for it. A public figure who was sincerely interested in knowing how California could pay for S.B. 562 would read the analysis and then state their opinion, even if their opinion is ‘this analysis is a piece of shit and here are the reasons why it is a piece of shit’.

And yes, one way or another, in order for single payer to happen in California it will have to pass as a ballot initiative. That is true regardless of the effects of Proposition 98. We know that, and the activists are already making long-term preparations. We still would prefer to have the Assembly pass the bill, and for the governor to sign it, because that will improve the odds and speed the implementation of singly payer.

Oh, and then there’s that press release from the Assembly Democratic Caucus. It’s basically tone policing. No, I don’t condone death threats, and neither does the nurses’ association, but I think the accusation of ‘bullying’ and the comparison to schoolyard bullying is way out of line. It’s a very gross example of tone-policing. As one of the protesters who went to Sacramento and chanted ‘Rendon, Rendon, Shame on You, Action Now on S.B. 562′ and saw some of the “violent” imagery, I though the nurses’ unions tactics were entirely appropriate. Really, the nurses’ union has been far nicer in its tactics and rhetoric than many Californians are using to oppose Trump, yet has the Assembly Democratic Caucus come out to denounce “the Resistance” for bullying Trump? Nope, nor should they, since the Resistance totally has the right to say mean things about Trump and use provocative imagery to protest him and “bully” him.

There is nothing wrong with being a sensitive person, but a politician who is so sensitive that they cannot handle pissed off constituents using imagery like this to protest his decisions is not qualified for a high-profile office. If Rendon is too sensitive to cope with this, he needs to find a different career for his own well-being.

Though I don’t agree with every statement Jimmy Dore makes in this video, I generally agree with his analysis of the press release.

All that said, the press release is a good sign in that is shows that the California Assembly has been bothered by the protests. That is part of the point of protest – to bother public figures until they act differently. It would be worse if the California Assembly were completely indifferent to the protests.

I actually have my own qualms with some of the tactics that some advocates of S.B. 562 us, but a) those qualms aren’t related to anything the Assembly Democrat Caucus mentions in the press release and b) I would rather invest effort in passing S.B. 562, or any single payer legislation which might work, than to criticize the tactics of allies who are working even harder than I am to get single payer in California.

And I am really irritated by the title of this article in the San Francisco Chronicle = “Infighting among allies over state‚Äôs tabled health care bill” Excuse me, how is Rendon an ally? Okay, maybe they just mean that the nurses’ union has historically been an ally of the Democrat Party, but I think even the implication that Rendon is an ally of single-payer advocates is wrong. Is he an ally because he claims to support single payer? Well, you know who else has said that he supports single payer? Donald Trump. If Rendon is an ally of the single payer movement, then so is Trump. Of course, we know that, in spite of what he has said, that Trump is not ally, because if he were, he’s be pushing Medicare-for-all right now. Likewise, if Rendon were an ally of the single-payer movement, he would either be pushing S.B. 562 (possibly with amendments) or he would write his own single-payer legislation.

In May, single-payer advocates marched through the California Democrat Convention in Sacramento. I was there, marching with my “Make California a Healthcare Sanctuary” sign. At one point, one of the attendees of the convention, wearing a posh dress, pulled me aside to ask “Are we on the same side?” This was so unexpected that I did not know what to say, so rather than remain separated from the group, I just returned to the group without answering her question. However, in retrospect, the answer I would have liked to have given her is “If you want to make single payer happen, then we are on the same side. If you do not want single payer to happen, then we are not.”

Thoughts on Justice Democrats and Brand New Congress

Congress is the most powerful branch of the national government of the United States. It is also the most transparent and democratic branch. I don’t think it’s a coincidence that, according to Neil M. Barofsky’s important book Bailout, Congress is also the least corrupt branch of the national government (if you care about American politics, I highly recommend reading Bailout). Given that Congress is a) the most powerful and b) the most subject to democratic control, it seems to me the obvious place to push for change.

This is part of why I was so puzzled that people said that the Democratic Party was in much better shape than the Republican Party in October 2016. First of all, unlike nearly everybody in my social circle, who were all certain that Clinton was going to win, I was expecting a close election and that either Clinton or Trump could win it. It turns out I was right and they were wrong (that does not mean I’m happy about being right in this case). However, aside from the Presidential election, the Democrats had not had a majority in the House since 2010, and have been bleeding seats in state legislatures all over the country. Even if Pennsylvania, Michigan, and Wisconsin had given their electoral college votes to Clinton, it would not have changed the outcomes of the congressional and state legislature elections.

I find it frustrating that people focus so much on the presidency that they ignore so much of what is happening in Congress, let alone the state governments. For example, when I went to vote in 2008, I was shocked by how crowded it was. There were not nearly so many people at the polls in 2006, when there was an election for the governor. The thing is, with the way the electoral college is set up, voting for POTUS in California does not make a difference, and this has been true ever since California has been a state. In other words, California votes have never mattered for electing a POTUS. California votes do matter a great deal for electing the governor, and the governor (or, as we called him in 2008, the ‘governator’) has more power over California affairs than the POTUS. Granted, the infamous Proposition 8 was also on the ballot in 2008, but had Proposition 8 been on the 2006 ballot rather than the 2008 ballot, would the crowds have shown up in 2006 instead of 2008? I will never know.

Personally, I think the fact that a) the Republicans control almost enough state legislatures to pass constitutional amendments without Democrats and b) the way some state legislatures are acting to dismantle democracy (most notably in North Carolina, where they elected a new governor because their previous governor was unpopular, and the legislature responded by gutting the newly elected governor of his powers) is scarier than the election of Trump. The election of Trump, in itself, is (flawed) democracy in action, not a dismantling of democracy (the electoral college is a problem, but an old one, not a new one) (what Trump may do in office to undermine democracy is something else). A lame duck state legislature gutting the powers of the newly elected governor is a direct dismantlement of democracy. Furthermore, I found out just today that the Arizona Senate has voted for a bill which would allow police to arrest people organizing peaceful protests, even if those protest organizers have not harmed anyone or damaged any property.

However, I don’t think there is much I can do about the North Carolina or Arizona state governments. I can do some small things about the California state government, and on that note, a PSA for fellow Californians: tell Governor Jerry Brown to ask CALPERS board member Bill Slaton to resign. Even though California votes don’t count for POTUS elections, the California government does control CALPERS, one of the most powerful investors in the world. Arguably, having control over CALPERS grants more power than a pile of electoral college votes. The problem now is that CALPERS is going rogue and behaving in a way which is harmful to Californians, which is why citizens need to intervene.

I also can do some small things about the national legislature, Congress.

So, with all that said, I have great interest in what will happen in the 2018 midterm elections. And two groups, the Justice Democrats and Brand New Congress have come to my attention. These are two groups which are starting to work now to change Congress in the 2018 elections.

I agree with most of the Justice Democrats’ platform, and the parts I disagree with are issues I am willing to compromise on. In other words, I would be very happy to see a majority of Congress adopt this type of platform. However, since they are a new group, there is relatively little information about them. I will keep a critical eye on them.

As the Justice Democrats’ said in one of their emails (yes, I am on their email list because I want to learn more about them), their endgame is different from that of Brand New Congress (BNC), but they have decided to work together because the work that needs to be done is so overwhelming that they need partners. BNC, based on what I was able to learn, seems to be run by former campaigners for Bernie Sanders. I prefer the platform of the Justice Democrats over the platform of BNC, but the BNC platform is also a significant improvement over status quo.

The thing which most concerned me about the BNC when I first learned about them was that it seemed they were going to recruit almost exclusively from people who have no experience with elected office. Now, I see on their website that they are not going to exclude all people with elected office experience, but I’m still concerned on their drive to recruit people without an elected office track record. Why? I could take the easy way out by just saying “look at Trump, the first POTUS with no prior experience in elected office” but I will explain. First of all, without a record of what a candidate has done in elected office, it’s much harder to predict what they will do when elected. Second, inexperienced people tend to be less competent than experienced people. Inexperienced politicians are more likely to cave to oligarchs. This happened in California when term limits were imposed – the California legislature got a flood of inexperienced legislatures who were so clueless that they depended on lobbyists to ‘help’ them do their jobs far more than the incumbents they replaced. Yes, many of the incumbents were corrupt, but they at least had a more independent power base, and thus greater leeway to tell big money interests “Fuck You.”

That is not to say that all members of Congress need to have experience in elected office. I think there are teachers, nurses, factory workers, etc. who would be fine congressional representatives (especially if they have experience with union politics). However, I am worried about what would happen if the majority of Congress did not have prior experience with elected office.

On the other hand, given the powerful antipathy voters feel towards ‘career politicians’ these days, maybe recruiting primarily ‘ordinary people’ to be candidates is a good strategy for winning elections.

I am also concerned about the centralized campaign that BNC proposes. On the one hand, maybe that is exactly the kind of thing which is necessary to win elections. However, my concern is that it will become too centralized, and power will be concentrated in too few hands. Then again, power is already concentrated in too few hands, namely in the hands the oligarchs, so perhaps being ruled by whoever controls BNC will be a major improvement, even if power is too concentrated.

BNC says they are going to prepare legislation this year, and that it will be released to the public before the 2018 elections, and that all of their candidates will pledge to vote for the legislation that BNC drafts. I look forward to seeing what BNC will come up with. Or maybe that is too passive an approach. Maybe it’s better if I tell them what I want, even though BNC currently is not soliciting from the general public what the general public wants in their legislation. And that is also a bit of a concern for me. They’re drafting candidates, but they are not soliciting input for what voters want to put into their legislation? Hmmmm.